What is scoliosis?
Scoliosis is when the spine curves to the side. The spine can also twist at the same time. This twisting can pull the ribcage out of position. It is important that a person with scoliosis sees a scoliosis specialist. Scoliosis is not a disease. It just means that in an often otherwise healthy person the spine is curved or twisted. It is not infectious or contagious. It does not develop because of anything a person did or did not do. Although many people have not heard of scoliosis it is not rare. 3 to 4 children per 1000 need specialist supervision. Scoliosis can affect people at different points in their lives. It can happen:
- Before birth (congenital)
- In young children (early onset),
- In older children and teenagers
- As adults
Scoliosis can affect a person’s appearance because when the spine bends to the side, the small bones that make up the spine (called vertebrae) can become twisted. The twisted vertebrae can pull the ribs round with them, which sometimes causes a lump to form on the person’s back or for their back to appear rounded. Other possible signs of scoliosis are a shoulder blade that sticks out or an uneven waist. The spine can curve to the left or the right. The curve can happen in different parts of the spine. It might be in the chest area, which is called ‘thoracic’ scoliosis. It might be in the lower, ‘lumbar’ area of the spine. A large thoracic curve can affect how well the lungs work. Sometimes there are two curves and the spine may look like an S shape from behind. This is called a ‘double curvature’. When the curve is S-shaped a person’s spine can appear quite straight because the two curves cancel each other out.
Types of scoliosis
Congenital scoliosis
Congenital scoliosis is a type of scoliosis that you are born with. The word congenital means that the condition is present at birth. This type of scoliosis happens because the spine does not develop fully in the womb. It differs from another type of scoliosis that may be discovered in young children, early onset scoliosis. It is important that all children with congenital or early onset scoliosis stay under the care of a scoliosis specialist while they grow.
Early onset scoliosis
Early onset scoliosis is when a curve appears between birth and age 10, or before puberty. Usually, early onset scoliosis is idiopathic. The word idiopathic means that there is no known cause.
Adolescent idiopathic scoliosis
Adolescent idiopathic scoliosis is a change in the shape of the spine during the child’s growth. It results in the spine curving sideways and twisting at the same time. This twisting can pull the ribcage out of position, often leading to a hump on one side of the ribs. When this happens between ages 10 and 18 it is called adolescent idiopathic scoliosis (AIS).
Adult Degenerative scoliosis
Adult degenerative scoliosis is divided into two categories. Degenerative scoliosis happens to an adult who has had a history of scoliosis. The spine starts to show wear and tear due to age. This wear and tear can cause the spine to collapse, causing the curve to increase. De novo (new) scoliosis first appears in adulthood, due to wear and tear. Again, in this case, this can result in a curve of the spine. In both cases adult degenerative scoliosis is typically diagnosed after an adult reaches the age of 50.
Neuromuscular scoliosis
Neuromuscular scoliosis is a curvature of the spine caused by a neurological or muscular condition. Neurological conditions affect the body’s nervous system. Examples are cerebral palsy and spina bifida. Not all people with a neurological condition will develop scoliosis.
Syndromic scoliosis
Syndromic scoliosis means that a sideways curve of the spine develops as part of a syndrome. A syndrome is a condition that is made up of lots of symptoms (signs) that appear together.
Scheuermann’s kyphosis
Scheuermann’s kyphosis is a condition in which the front sections of the vertebrae (small bones that make up the spine) grow more slowly than the back sections during childhood.
AIS surgery
Adolescent Idiopathic Scoliosis (AIS) is the most common type of scoliosis. The curve tends to progress most at times of rapid growth, especially around the growth spurt in your teenage years. Specialists will sometimes have slightly different ideas about when surgery is necessary, but all will consider factors such as how big your curve is and how much growing you have left to do. As a general rule, if your curve is around 45-50 degrees or more, your surgeon will talk to you about the possibility of surgery. Your specialist will be able to look at your pelvis on the X-ray and tell how much growing you still have to do. This reading of the pelvis is called the Risser Sign. Your surgeon will also use other information, such as periods starting in girls or facial hair in boys. The goals of surgery are to prevent your scoliosis getting larger and to correct the curvature as much as can be done safely. If you still have a lot of growing to do, your curve might progress and get bigger as you grow. If you have finished most of your growth but you have a curve of 50 degrees or more, it may continue to get bigger as an adult.
Bracing
When is bracing used as a treatment? Braces are mainly used for children and adolescents who have small curves, and are still growing. Patients who have curves between 20˚ and 40˚ during a growth spurt would be the most likely to benefit from bracing. As well as the rate of growth and the size of the curve, other factors that affect the likelihood of a curve getting worse are:
- How mature the child’s bones are. The more mature the bone, the less likely the curve is to get worse. The specialist can see this from the child’s X-ray.
- The patient’s family history of scoliosis. Recent research suggests that patients with a family history of scoliosis have a higher risk of curve progression.
- Sex of the child. Girls are more likely to have progressive curves, with the ratio of girls to boys increasing with curve size.
Spinal fusion
Most surgery is done from the back (posterior). Sometimes the surgeon will operate from the side (lateral surgery) or the front (anterior surgery). For very large, stiff curves they might operate from both the back and the side. Spinal fusion uses metal implants (screws, wires, and/ or hooks) that are attached to the vertebrae (the small bones that make up the spine) and then connected to 2 rods. During the operation, bone graft is placed over the implants. Over a period of about 12 months the bone graft fuses (grows together) with the existing bone in your spine and forms a solid column of bone in that area. The implants and rods hold the spine in place until it is fused. They are not usually removed. You may lose some flexibility where your spine has fused. However, a lot of the bending we do is from the hips, and lots of people report very little change to how they can move after the operation. How much flexibility you have depends on how much of your spine is fused.
Source-
Home - Scoliosis Association (sauk.org.uk)